MEDICARE: MS. LATISA BELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1154844389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATISA BELL

Provider Business Mailing Address
First Line	:	PO BOX 7509
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-0509
Country	:	US
Telephone Number	:	862-235-8613
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 SPRINGDALE AVE UNIT B
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-4819
Country	:	US
Telephone Number	:	862-235-8613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/19/2017

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